| Lakeville Family Practice | |
|
20157 Icenic Trail Lakeville MN 55044 | |
| (952) 469-3393 | |
| (952) 469-3399 |
| Full Name | Lakeville Family Practice |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 20157 Icenic Trail, Lakeville, Minnesota |
| Authorized Official Name and Position | Mark S. Mellstrom (OWNER) |
| Authorized Official Contact | 9524693393 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lakeville Family Practice 20157 Icenic Trail Lakeville MN 55044 Ph: (952) 469-3393 | Lakeville Family Practice 20157 Icenic Trail Lakeville MN 55044 Ph: (952) 469-3393 |
| NPI Number | 1629244686 |
|---|---|
| Provider Enumeration Date | 04/30/2008 |
| Last Update Date | 04/30/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629244686 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 6208286 (Minnesota) | Primary |
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